In Medicine, Falling for Fake Innovation

THE sleek, four-armed “da Vinci” robot has been called a breakthrough technology for procedures like prostate surgery. “Imagine,” the manufacturer says, “having the benefits of a definitive treatment but with the potential for significantly less pain, a shorter hospital stay, faster return to normal daily activities.”

That’s just the kind of impressive-sounding innovation that critics of the health care reform act say will be stifled by the new law, with its emphasis on cost control and the comparative effectiveness of new pills and devices. “Instead of encouraging innovation,” wrote Senator Ron Johnson, Republican of Wisconsin, in The Wall Street Journal, “it stifles creativity.”

The critics are right — if they’re talking about innovations like the da Vinci robot, which costs more than a million dollars and yet has never been shown by a randomized trial to improve the outcomes of prostate surgery. Indeed, a 2009 study showed that while patients had shorter hospital stays and fewer surgical complications like blood loss when they underwent this kind of robotic surgery, they later “experienced more … incontinence and erectile dysfunction.” Similar problems are occurring with robotic surgery for other cancers.

In other words, this is a pseudo-innovation — a technology that increases costs without improving patients’ health.

The Affordable Care Act will not reward this kind of innovation. But by providing incentives for hospitals to reduce infections, errors and readmissions, giving doctors more information on the comparative effectiveness of medical interventions and emphasizing preventive care over expensive services, the act will stimulate a panoply of true medical innovations. These may not be flashy; they might not even be visible to patients. But they will improve health care and lower costs.

For instance: checklists. A 2006 study showed that a five-item checklist — including hand-washing and cleaning a patient’s skin — could reduce infection rates from intravenous catheters to nearly zero. According to the study, these infections cost an average of $45,000 per patient, and cause as many as 28,000 deaths among intensive care unit patients each year.

By the end of the decade, we will see many other true innovations — small and large, high-tech and non-tech. Diabetics’ smartphone applications could transmit their glucose levels to doctors’ offices; wireless home monitoring systems could be installed for patients with congestive heart failure; high-tech caps for drug bottles could alert patients’ families if they forget to take their medications. There will also be many innovations in electronic health records. These aren’t flashy robots, gleaming scanners or new pills, but there is already evidence that they will save money and improve care.

We have benefited tremendously from medical innovations like M.R.I. scanners, cardiac stents and powerful new drugs, and should celebrate the fact that the United States is the leader in developing medical technologies. But we need to stop glorifying every new technology as an innovation. “New” matters only when it’s proved better than what we had before, when it prolongs survival, reduces side effects or improves quality of life — or maintains the current standard of care at a lower cost.

Health care reform may quash pseudo-innovations, but that simply directs capital and creativity away from technologies that don’t improve outcomes or lower costs and toward ones that do. That should not be confused with killing innovation.

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Ezekiel J. Emanuel, an oncologist and former White House adviser, is a vice provost and professor at the University of Pennsylvania. He is a contributing opinion writer for The New York Times on a range of topics including health and health policy. Topher Spiro is the vice president for health policy at the Center for American Progress.